Social Security Disability Appellants Fight Uphill Battle

In a case from the United States Court of Appeals for the Fifth Circuit, the claimant filed for Social Security Disability Insurance (SSDI) benefits because she suffered from various physical and mental impairments. This case deals with the issue of whether an administrative law judge (ALJ) can disregard a treating physician’s opinion. An ALJ is a hearing officer at the U.S. Social Security Administration (SSA), which is the federal agency that oversees the disability benefits programs.

Under the relevant statute in the U.S. Code, the ALJ has the authority to find against the opinion of the treating physician, but in order to do so, that decision must be supported by sufficient evidence, and it must be clearly explained in the record why the treating doctor’s decision is being disregarded.
In this case, the court of appeals found ALJ had erred as a matter of law, as he had rejected the treating physician’s opinion and did not adequately explain or justify his reason for doing so in the record. With respect to her debilitating conditions, claimant went to the emergency room after a 2006 car accident. She was severely injured in this serious car accident, as she had broken bones in her foot, cut her eye and her arm, and suffered a number of fractures in her ribs. Her foot required a metal plate and screws that were implanted by an orthopedic surgeon.

Ultimately, surgeons were able to correct her foot to the point where imaging showed evidence of straight alignment, but she was in a state of increasing pain and could not go back to work. Specifically, her surgeon noted in her medical records that her foot was still extremely swollen, visibly crushed in an area known as the calcaneus, had angular problems and was very arthritic. Her doctor opined that she could not work at any job that required her to stand for more than a half hour and she could not walk more than 50 yards.

These physical ailments from the car accident were not the only basis upon which she filed for Social Security disability benefits, as she was also suffering from various cognitive and psychological impairments. As our Boston disability benefits lawyers can explain, in many cases it is not enough to get disability on one debilitating condition alone, depending on the severity of that condition. For this reason, it is often necessary to include any mental disabilities from which you may be suffering. This can include both cognitive and psychological ailments.

In this case, the claimant had not graduated from high school and did not obtain a GED. She also was diagnosed as being bipolar, having mild mental retardation, and a pain disorder. Her scaled IQ score was 69.

After plaintiff presented various reports and testimony from several medical professionals, including her orthopedic surgeon and a psychologist, the ALJ engaged in the practice of asking hypothetical questions to a vocational expert (VE) about what type of work someone with the same medical conditions as the plaintiff could do. The VE opined that the claimant could work as an escort driver or work at an assembly plant. This obviously did not fit with what her doctors had said, yet the ALJ decided to find she was not disabled and did not give any reasons for overriding the treating doctor’s opinion.

If you or a loved one is seeking Social Security Disability Insurance in Boston, call for a free and confidential appointment at 1-888-367-2900.